Network Participation

Blue Cross and Blue Shield of Oklahoma (BCBSOK) contracts with physicians and other professional providers to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services to our members.

If you are interested in applying to join our provider networks, follow the steps outlined below. We look forward to working with you!

NOTE: Hospitals, Ambulatory Surgery Centers and Ancillary Providers should send an email to OKNetworkManagement@bcbsok.com to request information regarding how to join our networks.

FIVE EASY STEPS TO JOIN!

• Step 1 — Complete Provider Onboarding Form.

  To apply to join our networks, you will need to complete the Provider Onboarding Form .
  (For the best user experience, use Chrome browser.)

  Solo Provider Onboarding

  Complete the Solo Provider Onboarding Form if:

  • You are a new solo provider that is practicing under your own SSN or EIN without a Level 2-Organzational NPI

  Group/Clinic Provider Onboarding

  Complete the Group/Clinic Provider Onboarding Form if:

  • You are a new provider being added to an existing group with a Level 2-Organization NPI
  • You are a new group/provider with a Level 2-Organization NPI

  Each provider interested in becoming contracted with BCBSOK should attach the following when completing the Provider Onboarding Form, as applicable. Incomplete submissions will be rejected.
  

   

  Required for all Providers:

  • Current Oklahoma State Healthcare License
  • Malpractice Liability Insurance
  • Provider Disclosure of Ownership and Control Interest Form
  • Valid W-9

  As applicable by provider type:

  • Behavioral Health Professional Areas of Expertise
  • Call Coverage Designation & Credentialing Contact Information
  • Clinical Laboratory Improvement Amendments (CLIA)
  • Federal DEA license and State Controlled Substance registration
  • Hospital Coverage Letter
  • Physician (MD/DO), Oral Surgeon (DDS/DMD) or Podiatrist (DPM) Prescribing Authority Supplemental Questionnaire
  • Physician Assistants Supervising/ Collaborating/Monitoring Physician Protocols/Duties/Scope of Practice Supplemental Questionnaire
  • Advanced Practice Nurses Collaborating/Supervising/Monitoring Physician Protocols/Duties/Scope of Practice Supplemental Questionnaire
  • Advanced Practice Nurse Prescribing Authority Supplemental Questionnaire
  • Physician Assistant Prescribing Authority Supplemental Questionnaire

• Step 2 — Initial review process

  Requests to join the BCBSOK network are reviewed by a multi-disciplinary team. We make every effort to keep health insurance affordable and accessible to all Oklahomans. As part of that commitment, we actively seek relationships that foster a partnership between our organization and providers and address network needs.

  After review, we will notify you of whether you may proceed to Step 3.

• Step 3 — Become credentialed

  All providers who participate in our networks are required to complete the credentialing process. Our credentialing requirements follow applicable law and accreditation standards.

  For more information review the APRN (CNP and CNS) Credentialing Process.

  If you are credentialed through this process, you may proceed to Step 4. If you are not approved, we will notify you of the outcome and any applicable appeal rights.

• Step 4 — Submit a signed contract

  If you successfully complete Steps 1-3, you may receive a contract for participation in one or more BCBSOK networks. After we receive your signed contract(s), you will receive a welcome letter that specifies your network effective date(s).

• Step 5 — Get connected.

  Once you are part of our networks, we strongly encourage you to use all available electronic options for electronic data interchange (EDI) transactions to help ensure timeliness, accuracy and security of claims-related information. Please visit the Electronic Commerce section of our website under "Claims and Eligibility".

  
  

  NOTE: Completing a Provider Onboarding Form or any other process described above in Steps 1-3 does NOT mean that you are a participating provider or guarantee that a contract will be offered.

Case Status Checker

If you have completed one of the following and would like to check the status, enter the case number you received in your confirmation email in our Case Status Checker .

• Provider Onboarding Form
• Demographic Update Form
• General Email inquiries

Credentialing Status Checker

After you submit the Provider Onboarding Form to get credentialed, check the status of your credentialing process by entering your NPI or license number in our Credentialing Status Checker .

Credentialing is the process by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.

Effective May 17, 2010, the Council for Affordable Quality Healthcare, Inc. (CAQH) will collect the data required for our credentialing and recredentialing process. CAQH uses a Universal Provider Datasource® (UPD) form to electronically collect the data. This online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Providers may utilize the UPD at no cost.

The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the Universal Provider Datasource.

Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:

• Right to review information submitted on or with their credentialing and recredentialing application;
• Right to correct erroneous information;
• Right to be informed of the status of their credentialing or recredentialing application, upon request.

Applicants should direct all requests to their Network Management Representative. The Enterprise Credentialing Department will notify the Applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be given sufficient time to correct erroneous information and resubmit to the Enterprise Credentialing Department. It will be the Applicant's responsibility to work directly with the reporting entity(ies) to correct the erroneous information.

All BCBSOK providers must have a CAQH Provider ID to register and begin the credentialing process.

First time CAQH users

• If you are not registered with CAQH and are a first-time user, when you apply for network participation, we will add your name to our roster with CAQH. CAQH will mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate online access to the UPD.
• When you receive your CAQH Provider ID, go to the CAQH website to register. After validating key information, you will be able to create your own user name and unique password to begin using the UPD database.
• Once registration is completed, you may use your user name and password to log in at any time.

Existing CAQH users

• If you are already registered with CAQH through another health plan, log in to the UPD and add BCBSOK as one of the health plans that can access your information.
• Go to https://upd.caqh.org/ (type address into browser), and enter your username and password.
• Click the "Authorize" tab located under the CAQH logo.
• Scroll down, locate BCBSOK, and check the box beside BCBSOK. You may also select "global authorization." If you have chosen "global authorization," then BCBSOK will already have access to your data.
• Click “Save” to submit your changes.

The UPD standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center.

When you are ready to begin entering your data, log in to the UPD with your user name and password.

The following materials are helpful to reference while applying:

• Previously completed credentialing application
• List of previous and current practice locations
• Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
• State medical license(s)
• Curriculum Vitae
• Drug Enforcement Administration Certificate
• Controlled and Dangerous Substances Certificate
• IRS Form W-9(s)
• Malpractice insurance face sheet
• Summary of any pending or settled malpractice cases

After completing the application, you will also be asked to:

1. Authorize access to your information – List the organizations that you would like to receive your information. You may select "BCBSOK" or "global authorization."
2. Verify your data entry – Review a summary of your data for completeness and to make any changes as necessary.
3. Submit supporting documents – To complete your application, fax the supporting documentation to CAQH at (866) 293-0414.

If you have any questions on accessing the UPD database, you may contact the CAQH Help Desk at (888) 599-1771 for assistance.

BCBSOK may need to supplement, clarify, or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through the UPD.  You will receive notification if any additional information is needed by BCBSOK.

Visit the CAQH website for more information about the UPD and the application process. You may also contact your BCBSOK provider representative with any questions regarding this new procedure.

The APRN (CNP and CNS) Credentialing Requirements

Blue Cross and Blue Shield of Oklahoma (BCBSOK)'s credentialing process follows the national Consensus Model for Advanced Practice Registered Nursing (APRN) (Certified Nurse Practitioner (CNP) and Certified Nurse Specialist (CNS): Licensure, Accreditation, Certification and Education.

Need to Know: APRN's education and certification specialty must align with their scope of practice. The practice location of the APRN should be consistent with both the population focus and area of emphasis/specialty (if applicable) listed on his/her license.

BCBSOK reviews the following elements as part of its criteria when considering an APRN's application for network participation and credentialing:

• Licensing
• A description of the APRN's current practice (Sections 3, 7 and/or 8 of the Uniform Credentialing Application)
• Details regarding certification, training and education (Sections 5 and 10 of the Uniform Credential Application)
• Sponsorship for Prescriptive Authority (if applicable)
• Copies of the BNDD and CDS and a Curriculum Vitae (Section 12 of the Uniform Credentialing Application)

Forms Required by BCBSOK for Credentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form(s) and forward to BCBSTX:

• Hospital Coverage Letter  – required to be submitted to BCBSOK for those providers who do not have admitting privileges at a participating network hospital.
• PA Supplemental Questionnaire – Prescribing Authority  – required for a PA who plans to prescribe controlled substances and holds a current DEA and State Controlled Substance Certificate.
• Supervising Physician and Protocols & Duties Supplemental Questionnaire  – required for Physician Assistant to provide the name of their Supervising Physician and attest to having protocol/duties.

Keeping your information current is your responsibility. You will be sent automatic reminders to review and attest to the accuracy of your data. Use the CAQH database to report any changes to your practice, in accordance with the time frames outlined in the State of Oklahoma.

You must enter your changes into the UPD database for us to access. Only health plans that participate in the UPD and that have been authorized by you to access your information will receive any changes.

CAQH requires you to review and attest to your data once every four months. At the time you are scheduled for recredentialing, BCBSOK will send your name to CAQH to determine if you have already completed the UPD credentialing process. If so, we will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you. The process of recredentialing is identical to that for credentialing and is consistent with URAC and State of Oklahoma requirements.

If your application is not available to BCBSOK, you will be added to our roster. CAQH will send you a registration letter and a CAQH Provider ID so that you can complete the UPD credentialing process. This will help you continue to conform to the requirements of your BCBSOK contract.

Upon completion of the recredentialing process, providers are considered approved unless notified otherwise. Notification of the recredentialing decision, other than approval, will be mailed within ten (10) business days of the decision.

Office hours must reflect each practice location, facility and individual provider. All provider applications request office hours be submitted. Our members rely on the accuracy of the provider information in our Provider Finder^®. If the office hours are not submitted on the application, office hours will be listed as 8 a.m. to 5 p.m. If this is an inaccurate representation of your hours, please update the correct information in the Demographic Change Form.